By Abbe Feder, Fertility Coach
Knowledge is power. Plain and simple, the more we know about anything—but specifically our health—the more we can maintain control, make informed decisions, and manage our health needs and overall well-being. Sometimes we learn too late that there are preventive or proactive measures to a better health outcome. It is easier to understand or analyze something after it has happened, instead of predicting or anticipating how it will be beforehand. Unfortunately, after something happens or doesn’t go our way, it may be too late, especially as it relates to health.
We can’t talk about reproductive health without talking about comprehensive sexuality education (“sex-ed”), because what we learn as young people in sex-ed has the potential to frame how we handle our overall sexual choices, health, behavior, and responsibility in adulthood. According to the World Health Organization (WHO), “Comprehensive sexuality education is central to children and young people’s well-being, equipping them with the knowledge and skills they need to make healthy and responsible choices in their lives.” When we’re able to make empowered choices, we have better control over our bodies, our fertility, and family planning.
Sexual and reproductive health and rights
One of the most frustrating realities of reproductive healthcare specifically is that we don’t know what we don’t know. We are dependent on schools and family to teach us and our loved ones sex-ed, and this can become complicated for many reasons:
- “Traditional” sex-ed taught in schools has a clinical feel, making the topic feel awkward and uncomfortable for pre-teens, teenagers, or young adults who would feel far more confident if they learned from a closer, more trusted, evidence-based source about how contraception works
- The clinical approach targets science and biology, but doesn’t necessarily approach the general happenings in our bodies affecting our everyday life
- Local policymakers decide which topics are taught in a particular school district, or whether sex-ed is taught at all. Therefore, there is no consistency across different states and communities within the United States
- School-taught sex-ed usually doesn’t include any variety of sexual orientation, but rather focuses on cisgender, heterosexual relationships (again, varies by state), which is not a complete picture of our sexual and reproductive health landscape
There is so much that we learn too late, or as previously stated, we don’t know what we don’t know.
In my own 6-year infertility journey, which began in my early 30’s, I went in thinking I knew all I needed to know about how babies are made, including genetics and my own reproductive health status. I am college and post-graduate educated, the daughter of a mental health professional and a biologist, and yet there was so much that I didn’t know.
For example, I had no idea that we are born with all of the eggs we’ll ever have. I had no idea that once your reproductive age is 35 you’re called “geriatric” (ouch). Most of us think it’s “so easy” to get pregnant, not knowing the complex nuances that are needed. We’re told it can happen in mere seconds anytime, when in reality there is an extremely limited and specific window for success.
We have to understand the shortcomings of sex-ed in adolescence to understand where (and why!) we may fall short as adults, especially as it relates to reproductive health. In addition to inadequate sex-ed classes, there are also societal and cultural stigmas (amplified by social media) that hold us back from self-advocacy.
It bears repeating how imperative it is that we understand the “normal” in our bodies so that we know when something is off, especially when it comes to women’s health. So many women have terrible, painful, and debilitating periods, but they assume that it’s just the way it’s supposed to be. If these women don’t feel comfortable talking about their bodies and symptoms with family and healthcare providers, there is little hope that they will receive the support they need, nor will they be able to find any sort of diagnosis, treatment, or reproductive health services they may need.
This holds true for sexually transmitted infections (STIs) as well. There is so much stigma attached to STIs, when the reality is that half of people in the United States will sustain an STI in their lifetime, and half of new cases in the US are in people between ages 15 and 24. The stigma leads to embarrassment and shame, which can then lead to health risks from lack of diagnosis, treatment, or cure. This can become especially detrimental when undiagnosed STIs lead to infertility.
According to the American College of Obstetrics and Gynecology (ACOG), one of the primary underlying causes of infertility is pelvic inflammatory disease (PID). Two STIs in particular are responsible for PID: chlamydia and gonorrhea, which can both be absent of symptoms. Therefore, if routine testing isn’t maintained at least annually for STIs, a sexually active 16-year-old girl (for example) who feels too shy or anxious to go to her routine gynecological appointment could be setting herself up for PID, and then eventually infertility, at which point there is little she can do to reverse the condition. PID can also lead to ectopic pregnancy, as it affects the fallopian tubes, where conception takes place.
Without going down a rabbit hole, it is impossible to mention reproductive health and rights without talking about access to safe abortion care. Abortion care is synonymous with advocating for fertility health, as the incidence of pregnancy loss has been shown to be higher with in vitro fertilization (IVF) than without medical intervention (aka spontaneous pregnancy). It’s important to note that this increase isn’t necessarily due to the IVF process itself, but to the underlying fertility issues that lead someone to using IVF to achieve pregnancy. The method through which the pregnancy ends and is cleared out of the body is incredibly sensitive and important to the life of pregnant women, and their future fertility. Therefore, many women need safe abortion care to healthily terminate a pregnancy wreaking havoc on her body. And again, if knowledge is power, knowing where to turn (to a trusted professional) during these hard times is key.
Another important note: according to the Centers for Disease Control and Prevention (CDC), infertility is defined as not being able to get pregnant (conceive) after 1 year (or longer) of unprotected sex. And because fertility declines with age, some providers evaluate and treat women aged 35 years or older after 6 months of unprotected sex. But the truth still remains: you are your own best advocate. If you are struggling to conceive, or just want to learn more about your fertility, talk to your OB/GYN, or ask for a referral to and make an appointment with a fertility specialist (reproductive endocrinologist). Infertility may be more common that you realize, affecting 1 in 5 women of childbearing age. If there are any issues, a specialist can explain and help in the decision-making process for fertility treatment options, ranging from medication to assisted reproductive technology like IVF.
So, what do we do?
There’s a lot to process when we talk about reproductive health. The stakes are high, people are human (and therefore understandably sensitive), and our decisions today can affect our reproductive outcomes many years down the road. What is imperative to remember is that we control our health outcomes. While it’s true that we may have genetic or environmental health issues beyond our control, the management and care of these issues are up to us. That said, I know that it can be easier said than done to simply “not be shy” or “feel more comfortable” when we talk about navigating our bodies, especially in today’s health system.
Here are a few highlights to remember so that we can prioritize our reproductive healthcare with confidence and clarity:
- Doctors want us to speak up, ask questions, and keep them informed. This quote from Dr. Matthew Memoli, an infectious disease doctor at the National Institutes of Health (NIH), says it perfectly: “There’s no such thing as a dumb question in the doctor’s office. I try very hard to make my patients feel comfortable so that they feel comfortable asking questions, no matter how dumb they think the question is.” Even if the topic seems sensitive or embarrassing, it’s best to be honest
- Medical professionals are required by law to keep our matters confidential and private
I have high hopes that sex-ed in this country will shape up toward inclusivity and a deeper range of topics. In the meantime, remember always: knowledge is power. As soon as you know your body, your goals, your family dreams—you can take control of learning what tools you’ll need to achieve them. Do your own research and find your trusted people to help make you feel great, inside and out!